2 resources Billing for dual-eligible members When billing for members covered by both Medicare and Medicaid, accurate coordination between payers ensures timely reimbursement and fewer denials. Follow these key practices to streamline your process. 1. Verify eligibility monthly Dual-eligible members may experience coverage changes. Before submitting claims, confirm Medicare and Medicaid eligibility, plan enrollment, and covered services using the El Paso Health Provider portal or clearinghouse tools. 2. Bill Medicare first Medicare (or the Medicare Advantage plan) is usually primary. Once processed, submit the Medicare Remittance Advice (RA) or 835 file with your secondary claim to Medicaid or the MCO. Ensure that line items match between submissions. 3. Know what Medicare doesn’t cover Services such as Targeted Case Management (TCM), long-term care, and certain behavioral health or home-based services are billed directly to Medicaid as the primary payer. 4. Include denial or payment details If Medicare denies a claim, include denial information (e.g., CO-109) with your MCO submission to prevent “Other Insurance Coverage” or “Provider Liability” denials. 5. Avoid Provider Liability denials Ensure prior authorizations, proper documentation, and correct modifiers or place-of-service codes are included. Stay current with policy updates and Provider bulletins to avoid delays. For recurring issues or questions, contact your Provider Relations Representative or Claims Department. Together, we can ensure members receive the care they need and you receive timely payment. Special services for children of traveling farmworkers El Paso Health has special Medicaid services for the children of traveling farmworkers. The services include assistance with scheduling their upcoming Texas Health Steps exams, as well as vision, mental health, and transportation benefits for them. If you have any questions or would like to receive more information about these services for children of traveling farmworkers or would like for the program coordinator to provide an inservice to your staff, please call the Outreach Coordinator at 915-532-3778, ext. 1075. Where to call for STAR+PLUS authorizations Calling El Paso Health for your authorization inquiries is simple. You can reach us at 1-833-742-3127, listen to the prompts, and choose from the following selections: Press 3 for Providers. Press 3 for Long-Term Services and Supports (LTSS) authorizations. Press 4 for all other authorizations, including acute care authorizations. It is important for you to select the correct prompt to avoid longer wait times and avoid being transferred multiple times. El Paso Health thanks you for your partnership, and we look forward to continuing working together!
RkJQdWJsaXNoZXIy ODQ1MTY=